Retrospective study of neoadjuvant twelve week paclitaxel-carboplatin with trastuzumab and pertuzumab in HER2-positive breast cancer

Standard neoadjuvant therapy for early HER2-positive breast cancer consists of 18 weeks of carboplatin, docetaxel, trastuzumab, and pertuzumab. However, treatment intensity may limit feasibility in frail patients and exceed therapeutic needs in selected early-stage disease. A retrospective real-world study at Tel Aviv University (Israel) evaluated a 12-week neoadjuvant regimen of weekly paclitaxel and carboplatin administered with trastuzumab and pertuzumab (12wTCHP) for HER2-positive breast cancer. Of 44 eligible patients receiving 12wTCHP, 93% had invasive ductal carcinoma (IDC) and 64% were ER-positive. The majority (73%, median age 59 years) had stage IIA disease, whereas the remainder had stage IIB or stage III disease and were significantly older (median age 64 and 76 years, respectively). Grade 3-4 neutropenia (20%) and diarrhea (19%) were the most frequent toxicities. No treatment-related deaths occurred. The pathological complete response rate was 61%: 54% in ER-positive tumors and 75% in ER-negative tumors. After a median follow-up of 30 months, only two recurrences (5%) were observed. None of the patients with stage IIA IDC had disease recurrence. The authors conclude that neoadjuvant 12wTCHP was well tolerated and associated with high pCR and low early recurrence rates.